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evered •— <br />�� J-30 <br />City of Everett <br />Engineering Department <br />Sewer Application and Permit <br />NO. DATE <br />Service Address_ <br />— Utility Account No. <br />Billing Address <br />Connection PLrmit Fee <br />City, State, Zip _ <br />Connection Fee <br />Owner (Mortgagor)_ <br />Total Fee <br />Billing Name_ <br />Connection By <br />Phone— <br />DESCRIPTION - <br />Lot <br />Block <br />Division or Addition__ <br />Type Permit: <br />a <br />SEE SKETCH ATTACHED <br />INSPECTION <br />Signed <br />ustomer <br />Sewer District <br />Monthly Sewer Service <br />Monthly Sewer Constr. <br />Trunk <br />Lateral <br />Abutting Lot Line <br />N, S, E, W <br />Approved By — <br />City Engineer <br />Issued By <br />I nspec <br />Date I <br />No. 20999 <br />